Provider Demographics
NPI:1215032867
Name:LEE, SUNNY R (LCSW)
Entity Type:Individual
Prefix:
First Name:SUNNY
Middle Name:R
Last Name:LEE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 POPPS FERRY RD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2217
Mailing Address - Country:US
Mailing Address - Phone:228-396-1600
Mailing Address - Fax:228-396-5001
Practice Address - Street 1:1636 POPPS FERRY RD
Practice Address - Street 2:SUITE 117
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2217
Practice Address - Country:US
Practice Address - Phone:228-396-1600
Practice Address - Fax:228-396-5001
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC6047104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS180096OtherVALUE OPTIONS
MS180151OtherCOMPSYCH
MS62-88956OtherUNITED BEHAVIORAL HEALTH
MS125297573899OtherHUMANA
MS174456OtherCOMPSYCH
MS1179558OtherCIGNA
MS0119005Medicaid